The smaller bowel: imaging the small bowel in paediatric Crohn's disease

Stuart, Sam; Conner, Thomas; Ahmed, Asia; Steward, Michael; Maclachlan, Jody; Wylie, Peter; Beal, Isobel

doi:10.1136/pgmj.2010.106641

Cited by 16 publications

(9 citation statements)

References 67 publications

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“…Additionally, PA imaging is a safe, non-invasive and non-ionizing modality, which matches the preferred characteristics of GI imaging, especially in the case of paediatric patients. 14 PA techniques are particularly useful for imaging exogenous near-infrared (NIR, 650–1000 nm) contrast agents. 15,16 Any luminal GI contrast agent should avoid systemic absorption into the body, since the subsequent loss of contrast agent from the intestine would lead to signal reduction, interfere with quantitative measurements and introduce toxicity concerns.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive multimodal functional imaging of the intestine with frozen micellar naphthalocyanines

et al. 2014

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OverviewThere is a need for safer and improved methods for non-invasive imaging of the gastrointestinal tract. Modalities based on X-ray radiation, magnetic resonance and ultrasound suffer from limitations with respect to safety, accessibility or lack of adequate contrast. Functional intestinal imaging of dynamic gut processes has not been practical using existing approaches. Here, we report the development of a family of nanoparticles that can withstand the harsh conditions of the stomach and intestine, avoid systemic absorption, and give rise to good optical contrast for photoacoustic imaging. The hydrophobicity of naphthalocyanine dyes was exploited to generate purified ~20 nm frozen micelles, which we call nanonaps, with tunable and large near-infrared absorption values (>1000). Unlike conventional chromophores, nanonaps exhibited non-shifting spectra at ultrahigh optical densities and, following oral administration in mice, passed safely through the gastrointestinal tract. Non-invasive, non-ionizing photoacoustic techniques were used to visualize nanonap intestinal distribution with low background and remarkable resolution with 0.5 cm depth, and enabled real-time intestinal functional imaging with ultrasound co-registration. Positron emission tomography following seamless nanonap radiolabelling allowed complementary whole body imaging.

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Section: Introductionmentioning

confidence: 99%

Non-invasive multimodal functional imaging of the intestine with frozen micellar naphthalocyanines

et al. 2014

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“…US has the distinct advantage of being widely available, inexpensive, non-invasive, radiation-free and relatively easy to perform [7,27] . Over the past few years, improvements in US equipment such as high-frequency transducers (7-12 MHz), combined with oral and intravenous (CE-US) contrast agents [28,29] , have overcome some of the obstacles in bowel US that existed in the past, thus raising a great enthusiasm for its use in IBD children.…”

Section: Ultrasonographymentioning

confidence: 99%

“…Moreover, patients with SB CD are more likely to experience complications, including intestinal obstruction and less commonly fistulization [4,5] . Thus, objective evaluation of the SB is essential in differentiating CD from other enteropathies and in directing the management of the patients with inflammatory bowel disease (IBD) [6,7] . The morphological evaluation of the SB, useful in the diagnosis and management of CD, has long been made only with conventional radiology.…”

Section: Introductionmentioning

confidence: 99%

Imaging of the small bowel: Crohn’s disease in paediatric patients

Casciani

Vincentiis

Polettini

et al. 2014

WJR

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In more than 20% of all patients, the Crohn's disease presents before the age of 18 years. The diagnosis and management of Crohn's disease in children has changed dramatically over the last decade, mainly due to increased awareness, availability of newer diagnostic modalities such as magnetic resonance imaging (MRI) and newer, more powerful treatments such as biologics. Imaging of the small bowel is needed for diagnosis, management, follow-up and also evaluation of the disease in terms of location, extent, activity and complications. We review all the methods (barium examinations, ultrasonography, computed tomography, MR, and computed tomography-positron emission tomography) commonly used for imaging the small bowel in paediatric patients with Crohn's disease analyzing the advantages and disadvantages of each modality, with particular emphasis on MR imaging.

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“…The ability to accurately assess the SB is crucial for determining optimal patient management. Until a few years ago, a fluoroscopic examination that included SB follow-through (SBFT) was the suggested technique for SB evaluation 4. In the past 2 decades, advances in cross-sectional image and capsule endoscopy (CE) have led to widespread use of these noninvasive and well-tolerated approaches 4 5 6.…”

Section: Introductionmentioning

confidence: 99%

Development of a predictive model of Crohn’s disease proximal small bowel involvement in capsule endoscopy evaluation

et al. 2016

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Background and study aims: One of the indications for capsule endoscopy (CE) is the detection of proximal small bowel (SB) involvement in Crohn's disease (CD) patients. Our aim was to assess clinical, laboratory and endoscopic predictors associated with proximal SB involvement in CD patients submitted to CE. Patients and methods: Retrospective multicenter study in which Lewis score (LS) was systematically determined in 190 CE of patients diagnosed with CD between 2003 and 2014. Results: Significant inflammatory activity (LS > 135) was present in 23 % of the patients in the first tertile and in 31 % of the patients in the second tertile. Albumin, haemoglobin, and total proteins were significantly lower in patients with a LS > 790 compared to patients with a LS < 135, while white blood cell counts and C-reactive protein were significantly higher. In the univariable analysis, a higher risk for proximal SB involvement at CE was associated with ileal involvement at ileocolonoscopy (OR 2.858, P = 0.006), higher platelets levels (OR 1.005, P = 0.004) and significant weight loss (OR 2.450, P = 0.006). In logistic regression, ileal involvement at ileocolonoscopy (OR 6.817, P = 0.003), stricturing behavior (OR 8.653, P = 0.011) and significant weight loss (OR 3.629, P = 0.028) were independently associated with proximal SB involvement at CE. Considering the ROC curve of this model, a cut-off > 0.249 predicts proximal SB involvement with 90 % sensitivity and 40 % specificity (AUROC 0.732). Conclusions: One-third of patients had proximal SB involvement. Predictive factors were significant weight loss, stricturing behaviour, and ileal involvement at ileocolonoscopy. These data help to select CD patients that benefit the most from performing a CE.

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The smaller bowel: imaging the small bowel in paediatric Crohn's disease

Cited by 16 publications

References 67 publications

Non-invasive multimodal functional imaging of the intestine with frozen micellar naphthalocyanines

Non-invasive multimodal functional imaging of the intestine with frozen micellar naphthalocyanines

Imaging of the small bowel: Crohn’s disease in paediatric patients

Development of a predictive model of Crohn’s disease proximal small bowel involvement in capsule endoscopy evaluation

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